American Journal of Rhinology & Allergy最新文献

{"title":"Upfront Draf III Strategy Often Less Costly for Severe CRS Requiring Surgery.","authors":"David K Lerner, Saawan Patel, Chau Phung, Alan D Workman, Glenn Pennington, Robert Stetson, Jennifer E Douglas, Michael A Kohanski, Nithin D Adappa, James N Palmer","doi":"10.1177/19458924251337788","DOIUrl":"10.1177/19458924251337788","url":null,"abstract":"<p><p>BackgroundDraf III procedures are considered to be time- and supply-intensive compared to standard functional endoscopic sinus surgery (FESS).ObjectiveTo quantify the cost of a Draf III compared to standard FESS and examine time- and supply-related cost factors.MethodsWe performed a retrospective analysis of inflammatory sinus surgeries at a tertiary care medical center from July 2021 to July 2023. The medical record was reviewed for patient factors and cost variables, and multivariable analysis was performed.ResultsThree hundred and fifty patients were included with a mean age of 50.6 years. One hundred and twenty-nine patients underwent a Draf III, 99 of whom (76.7%) underwent a Draf III as part of a full FESS whereas 30 (23.3%) underwent a targeted revision Draf III. Among all Draf III procedures, operating room and supply costs represented 63.1% ($6231.67) and 16.6% ($1638.46) of total costs, respectively, compared to 54.8% ($4912.46) and 14.5% ($1296.06) for standard FESS (both p < .001). The average total cost for a full FESS with Draf III was $10118.60, compared to $9414.29 for a targeted Draf III, and $8960.31 for standard FESS (n = 221). Using these values, we calculated that the approach of performing an upfront Draf III would be less costly relative to the approach of performing standard FESS with Draf II and then revision Draf III as needed when the expected revision rate exceeds 12.3%.ConclusionsSurgical costs associated with a FESS with Draf III are driven primarily by operating room time costs, to a greater degree even than for standard FESS. The cost of performing a full FESS with Draf III is not considerably higher than a standard FESS or a targeted Draf III revision, suggesting that an upfront Draf III may represent a relatively less costly treatment approach for patients at high risk of recurrent frontal disease.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"338-344"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Past, Present, and Future: Innovation is at Our Core.","authors":"Christopher Ito","doi":"10.1177/19458924251358032","DOIUrl":"https://doi.org/10.1177/19458924251358032","url":null,"abstract":"","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"39 5","pages":"336-337"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Quality of Life After Endoscopic Repair of Choanal Atresia in Children.","authors":"Tal Rozenblat, Roy Hod, Ethan Soudry, Eyal Raveh, Eitan Yaniv, Dror Gilony","doi":"10.1177/19458924251372243","DOIUrl":"https://doi.org/10.1177/19458924251372243","url":null,"abstract":"<p><p>IntroductionChildren with choanal atresia (CA) typically present with nasal obstruction and require surgical intervention to establish a patent airway. Transnasal endoscopic surgery is the preferred treatment approach. However, long-term outcome data are lacking. This study aims to assess the long-term outcomes and quality of life (QoL) after endoscopic repair of CA.MethodsChildren under age 18 years underwent endoscopic repair of CA using mucoperichondrial flaps developed from the nasal septum between 2007 and 2022. Their parents completed two standardized telephonic QoL questionnaires (Hebrew version, Sino-Nasal 5 (SN-5H) and Nasal Obstruction Symptom Evaluation (He-NOSE)).ResultsThe cohort consisted of 40 children, 60% female. Eight had syndromic disease; seven were born prematurely. Mean age at surgery was 25 days for bilateral atresia (65% of patients) and 3.8 years for unilateral atresia. Ten children, most with unilateral CA, needed revision surgery. The mean duration of follow-up was 3.1 years. At the last follow-up, 84.6% of the children had normal choanae, and the remainder had narrowed choanae. Mean time from last follow-up to the parental interview was 5.2 years. SN-5H and He-NOSE scores were similar to those of historical healthy subjects: 1.95 versus 1.76 (<i>P</i> = 0 .4) and 22.3 versus 14.9 (<i>P</i> = 0.08), respectively. Children born prematurely had a higher rate of sinus infections (<i>P</i> = 0 .01) and nasal congestion (<i>P</i> = 0 .05) than children born at term.ConclusionsLong-term follow-up of children who underwent endoscopic repair of CA using mucoperichondrial flaps showed a stable patent nasal passage with normal QoL for both unilateral and bilateral disease.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"19458924251372243"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Mupirocin Nasal Irrigations for Treatment of Refractory Chronic Rhinosinusitis After Endoscopic Sinus Surgery.","authors":"Russell A Whitehead, Vidit Talati, Ali M Baird, Grant S Owen, Romney Hansen, Peter Filip, Bobby A Tajudeen, Pete S Batra, Peter Papagiannopoulos","doi":"10.1177/19458924251343389","DOIUrl":"10.1177/19458924251343389","url":null,"abstract":"<p><p>BackgroundChronic rhinosinusitis (CRS) can be difficult to treat medically secondary to crusting and biofilms resistant to oral antibiotics. Treatment with topical antibiotics has grown in popularity due to their ability to administer a high local drug concentration while mitigating systemic effects. Published literature on topical antibiotic efficacy for CRS is mixed and sparse.ObjectiveTo describe the efficacy of postoperative topical mupirocin rinses in reducing objective and subjective markers of CRS disease severity.MethodsPatients with suspected biofilm formation following functional endoscopic sinus surgery who were treated with mupirocin 15 mg or 30 mg rinses twice daily between 2018-2023 were included. These patients' symptoms and endoscopic findings were refractory to high-volume steroid irrigations and oral antibiotics. Data collected involved comorbidities, rinse duration, concurrent therapies, Lund-Kennedy (LK) scores, sino-nasal outcome test-22 (SNOT) scores, and adverse effects. LK and SNOT scores were compared across 3 time points (preoperative, 3-month-postoperative-prerinse, postrinse) using one-way analysis of variance and Wilcoxon rank sum for pairwise comparisons.ResultsThirty patients were included. Average age was 63.3 years, 66.7% of patients were female, and 60% had nasal polyposis. There was a statistically significant decrease in LK scores between the 3-month-postoperative-prerinse period and the postrinse period (-0.92 ± 1.25; <i>P</i>-value = <b>.01</b>) whereas the SNOT-22 score reduction was not significantly different (<i>P</i>-value = .62). One patient reported a \"burning sensation\" and stopped after 4-weeks of treatment; no other adverse events were reported.ConclusionTopical mupirocin rinses may result in improvement of CRS burden on endoscopy without a significant reduction in symptoms. Additional studies are necessary to delineate the safety and appropriate duration and dosing of mupirocin rinses as well as to compare mupirocin to standard saline irrigations for treatment of recalcitrant CRS.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"364-370"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting the Success of Sphenopalatine Artery Ligation in the Management of Intractable Epistaxis-A Single-Centered Retrospective Analysis.","authors":"Joseph Latif, Emma Ho, Jordan Fuzi, Catherine Banks","doi":"10.1177/19458924251372241","DOIUrl":"https://doi.org/10.1177/19458924251372241","url":null,"abstract":"<p><p>BackgroundEndoscopic sphenopalatine artery ligation (ESPAL) is a safe and effective procedure to manage intractable epistaxis. However, in the literature, the peri-operative and patient factors which contribute to surgical success or failure have been poorly defined.ObjectiveThe purpose of this study was to identify the patient, disease and surgical factors which influence the effectiveness of ESPAL in the management of intractable epistaxis.MethodsAll ESPALs performed over a 14-year period at a single tertiary otolaryngology department to manage epistaxis refractory to conservative management were retrospectively analyzed. Recurrence of epistaxis was defined as any patient who presented to an emergency department with epistaxis on the same side as their previous ESPAL at any time post-operatively. Subjects were grouped as either a non-recurrence or recurrence group.Results40 patients underwent ESPAL to treat intractable epistaxis. Anticoagulation, smoking, and active malignancy were associated with higher rates of recurrence after ESPAL (<i>P</i> < .05). The recurrence rate was 20% with an average follow-up period of 5 years. The average time between ESPAL and epistaxis recurrence was 10 days. 50% (n = 4) of patients with recurrence required escalation to endovascular embolization. No patients had recurrence of epistaxis following additional radiological intervention.ConclusionOne in five patients experienced a recurrence in epistaxis following ESPAL within 3 weeks of their surgery. Smokers, patients on anticoagulation and patients with malignancy are more likely to experience recurrence. If re-presenting with epistaxis following ESPAL, patients are likely to require radiological intervention.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"19458924251372241"},"PeriodicalIF":2.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occult Nodal Involvement in Sinonasal Squamous Cell Carcinoma.","authors":"Samer T Elsamna, Aman M Patel, Ibraheem Shaikh, Lucy Revercomb, Vraj P Shah, Prayag Patel, Christina H Fang, Soly Baredes, Jean Anderson Eloy","doi":"10.1177/19458924251371257","DOIUrl":"https://doi.org/10.1177/19458924251371257","url":null,"abstract":"<p><p>BackgroundSinonasal squamous cell carcinoma (SNSCC) is an aggressive subtype of sinonasal cancer. While elective neck dissection (END) is not typically recommended for SNSCC, occult nodal involvement (ONI) may be present. We therefore sought to evaluate the incidence, associated factors, and survival impact of ONI in SNSCC.MethodsThe National Cancer Database was queried for patients with SNSCC from 2004 to 2016. Data regarding patient demographics, clinicopathology, and treatment were obtained. Univariate and multivariate logistic regression and Kaplan-Meier analyses were conducted to identify predictors of ONI with odds ratios (ORs) and overall survival.ResultsIn total, 522 patients satisfied inclusion criteria. Most patients were elderly (>60 years old, 55.0%), male (67.2%), White (86.4%), and insured with Medicare (44.1%). Cases of SNSCC most frequently involved the paranasal sinuses (69.7%), were T-stage 4 (50.6%), moderately differentiated (52.5%), underwent treatment at academic centers (76.4%), and lacked lymphovascular invasion (LVI, 84.4%). ONI was observed in 10.9% of patients. Following propensity score matching, ONI significantly negatively impacted survival: 3 year survival was 65% for patients without ONI and 35% for patients with ONI (log-rank <i>P</i> < .001). The highest rate of ONI was observed in patients with LVI (31.4%). On multivariate analysis, LVI was the sole predictor of ONI (OR: 6.75, 95% confidence interval: 3.09-14.73, <i>P</i> < .001).ConclusionsONI was identified in 10.9% of patients with SNSCC and was found to be a negative prognostic factor for survival. Patients with identified LVI may benefit from END.<b>Level of Evidence:</b> 4.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"19458924251371257"},"PeriodicalIF":2.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lactic Acid Metabolism-Related Gene May Act as a Prognostic Predictor by FARS2 in Nasopharyngeal Carcinoma.","authors":"Wenxuan Huang, Huanfeng Zhu, Xiang Cao, Guannan Zou, Zixuan Wang, Dan Zong","doi":"10.1177/19458924251334856","DOIUrl":"10.1177/19458924251334856","url":null,"abstract":"<p><p>BackgroundThis study aimed to investigate the clinical value of lactic acid metabolism-related genes (LRGs) in nasopharyngeal carcinoma (NPC).MethodsClinical and genetic information was extracted from the TGCA and Gene Expression Omnibus databases. Consistency clustering was employed to identify NPC subpopulations. Immune infiltration was appraised using TIMER, ESTIMATE, and MCPCounter. Functional analysis was conducted to elucidate potential mechanisms. A prognostic risk model was successfully constructed using the LASSO algorithm and multivariate Cox regression analysis. Phenotypic experiments were conducted to validate the glycolysis and lactic acid metabolism.ResultsAccording to prognostically LRG genes, two clusters were identified and exhibited significant difference in immune landscape, which indicated variations in immune status. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis revealed that the differentially expressed genes were predominantly implicated in immune-related pathways. These findings suggested that the LRG-based risk model could successfully predict the prognosis of NPC patients. Moreover, the risk model retained its predictive potency by stratifying patients with sex and age, with lower risk score patients displaying improved prognosis. In the training cohort, the low-risk group showed significantly lower stromal score, immune score, and ESTIMATE score compared with the high-risk group. To further enhance the precision of prognostic predictions, we developed a nomogram that integrated the risk model with clinical features. In the training cohort, the established nomogram could accurately predict the prognosis of NPC patients. Mechanically, the knockdown of FARS2 in NPC cells resulted in altered glycolysis and lactification. Deregulated FARS2 led to the accumulation of metabolic intensity, which resulted in the disruption of lactic acid metabolism.ConclusionThese results highlighted the potential association between LRGs expression and immune dysfunction, which might contribute to adverse prognosis in NPC patients. This study represented a pioneering effort in exploring the prognostic value of LRGs in NPC.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"309-321"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Era of Comprehensive Rhinology Is Here.","authors":"Michael Platt","doi":"10.1177/19458924251345232","DOIUrl":"https://doi.org/10.1177/19458924251345232","url":null,"abstract":"","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"39 4","pages":"256-258"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Oral Corticosteroid Use Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.","authors":"Justina Shafik, Kara Sangiuolo, Eden Sheinin, Juan Lin, Meryl B Kravitz, Elizabeth A Borowiec, Christina H Fang","doi":"10.1177/19458924251335075","DOIUrl":"10.1177/19458924251335075","url":null,"abstract":"<p><p>BackgroundPatients with chronic rhinosinusitis (CRS) refractory to medical management often require endoscopic sinus surgery (ESS). Oral corticosteroids (OCSs) are frequently prescribed postoperatively, but the evidence of their efficacy is limited.ObjectiveThe purpose of this study is to evaluate the efficacy of OCS use in patients with CRS following ESS.MethodsA systematic search was performed to identify studies examining the use of OCSs in patients undergoing ESS for CRS. The primary outcomes were sinonasal outcome test (SNOT) and Lund-Kennedy (LK) endoscopic scores. Secondary outcomes were visual analog scale (VAS) scores. Meta-analysis was conducted using a fixed effects model with a heterogeneity test via the I2 statistic.ResultsThe search yielded 1899 articles, and 22 were included in the qualitative analysis, 14 of which were randomized controlled trials with 793 total patients. OCS use differed based on type, dosage, and duration. Studies included in meta-analysis did not show a significant difference in SNOT (Standardized Mean Difference [SMD] -0.03, Confidence Interval [CI] -0.47-0.40, I2 0%), LK (SMD -0.20 CI -0.57-0.17 I2 58%), or VAS (SMD 0.19 CI -0.25-0.63 I2 54%) scores between steroid and non-steroid groups. Two studies that assessed OCSs in the allergic fungal rhinosinusitis (AFRS) subtype of CRS showed significant improvement in outcomes. Two additional studies examined OCS versus itraconazole in AFRS, with both groups showing improvement but neither one with greater significance.ConclusionThis study showed no significant difference in SNOT, LK, or VAS scores in patients with CRS who received OCSs following ESS. Given the limited number of studies in the analysis, further investigations are warranted before making recommendations.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"322-332"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum and Tissue Periostin Expression in Rhinosinusitis With Nasal Polyps.","authors":"Gerasimos Danielides, Spyridon Lygeros, Georgios Kyriakopoulos, Foteini Tsapardoni, Katerina Grafanaki, Constantinos Stathopoulos, Stephanos Naxakis, Vassileios Danielides","doi":"10.1177/19458924251332546","DOIUrl":"10.1177/19458924251332546","url":null,"abstract":"<p><p>BackgroundThere is increasing evidence of the contribution of periostin in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP).ObjectiveThis study aims to investigate the expression of periostin in nasal polyp tissue along with serum periostin and its potential function as a biomarker.MethodsThe study included 36 CRSwNP patients and 12 controls. Nasal polyp tissue from CRSwNP patients and inferior turbinate mucosa samples from controls were intraoperatively collected. <i>POSTN</i> gene mRNA expression from nasal polyp tissue was assessed with polymerase chain reaction and periostin levels on tissue samples were measured with ELISA and Western Blot. ELISA was performed to evaluate serum periostin on blood samples collected from patients undergoing functional endoscopic sinus surgery for CRSwNP (<i>n</i> = 36) and results were compared with assays performed on control subjects (<i>n</i> = 12).ResultsTissue periostin gene expression in terms of mRNA levels was significantly elevated in patients with CRSwNP than in healthy control subjects (<i>P</i>-value <.05). Τissue periostin values in CRSwNP patients were also significantly higher in CRSwNP compared to controls. A positive correlation between periostin levels and the presence of asthma and smoking was observed in the patient group. Serum periostin did not present a statistically significant difference between the 2 groups.ConclusionsOur data suggest that periostin expression is upregulated in nasal polyps and might determine a crucial role in the occurrence and evolution of the disease. Periostin appears to be a promising therapeutic target candidate in CRSwNP.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":" ","pages":"259-265"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}